This article is more than 5 years old. Information may no longer be current.
Many patients with AF often prescribed aspirin over anticoagulants
Click Here to Manage Email Alerts
More than one-third of patients with atrial fibrillation with an intermediate or high risk for stroke are prescribed aspirin instead of oral anticoagulants, despite guidelines suggesting otherwise, according to study data published in the Journal of the American College of Cardiology.
“Stroke prevention is critical to the management of AF patients,” Jonathan Hsu, MD, MAS, assistant clinical professor of medicine, cardiology and cardiac electrophysiology at the University of California, San Diego, said in a press release. “However, giving aspirin alone ... may not be the best treatment therapy because it is either minimally effective or not effective at all. ... [It] still comes with risks such as intracranial hemorrhage.”
Jonathan Hsu
The researchers sought to analyze patient and practice-level factors linked to prescribing aspirin alone vs. oral anticoagulants to patients with AF at risk for stroke. They used data from the National Cardiovascular Data Registry’s PINNACLE registry and assessed patients with CHADS2 (n = 210,380) or CHA2DS2-VASc scores (n = 294,642) of at least 2.
The researchers found that among patients with CHADS2 scores of at least 2, 80,371 (38.2%) were treated with aspirin alone, whereas 130,009 (61.8%) received warfarin or non-vitamin K antagonist oral anticoagulants.
Among patients with CHA2DS2-VASc scores of at least 2, 118,398 (40.2%) received aspirin alone and 174,244 (59.8%) were given warfarin or non-vitamin K antagonist oral anticoagulants.
When Hsu and colleagues performed a multivariable adjustment, they determined the following factors were associated with prescription of aspirin alone: hypertension, dyslipidemia, CAD, previous MI, angina (stable or unstable), recent CABG and peripheral artery disease.
Factors associated with more frequent prescription of oral anticoagulation included male sex, higher BMI, previous stroke or transient ischemic attack, previous systemic embolism and congestive HF, according to the researchers.
“Much of the underutilization of appropriate anticoagulant agents may be driven by either the perception that aspirin by itself is sufficient or that the risk of aspirin plus anticoagulation is not worth the benefit,” the researchers wrote. “... [T]here is clearly a continued lack of a guideline-adhering prescription of [oral anticoagulants] in U.S. [CV] specialist practices.” – by James Clark
Disclosure: Hsu reports receiving honoraria from Biotronik, Bristol-Myers Squibb, Janssen Pharmaceuticals, Medtronic and St. Jude Medical and research support from Biosense Webster and Biotronik. Please see the full study for a list of the other researchers’ relevant financial disclosures.
Click Here to Manage Email Alerts